Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants

Brennan, Ann-Marie; Fenton, Sarah E.; Murphy, Brendan P.; Kiely, Máiréad

doi:10.1177/0148607116686289

Cited by 19 publications

(23 citation statements)

References 27 publications

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Section: Introductionmentioning

confidence: 99%

“…The nutrition course of the preterm infant has more recently been described as three discrete nutrition phases, i.e., the parenteral nutrition (PN) phase when the infant in entirely dependent on PN for nutrition, the enteral nutrition (EN) phase when the infant is fully established on milk feeds, and the transition (TN) phase [ 1 , 2 , 3 ] when PN is being weaned with advancing enteral feeds. The TN phase is an extremely complex nutritional period characterized by multiple nutrient sources (PN and EN), and has been reported to last from 7 [ 1 ] to 10 days [ 2 ]. Despite some studies showing that early, high amino acid (AA) intakes were associated with improvements in growth, glycaemic tolerance and electrolyte homeostasis [ 4 ], the TN phase has recently been exposed as a period of cumulative nutrient deficits, in particular AA [ 1 ], and compromised growth [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The TN phase is an extremely complex nutritional period characterized by multiple nutrient sources (PN and EN), and has been reported to last from 7 [ 1 ] to 10 days [ 2 ]. Despite some studies showing that early, high amino acid (AA) intakes were associated with improvements in growth, glycaemic tolerance and electrolyte homeostasis [ 4 ], the TN phase has recently been exposed as a period of cumulative nutrient deficits, in particular AA [ 1 ], and compromised growth [ 3 ]. It has been reported that infants who experience growth failure in the TN phase are five times more likely to be discharged with a weight < 10th centile for corrected gestational age (GA) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there is a lack of specific nutrition recommendations for the TN phase. International recommended nutrient intakes (RI) are based on the infant being either solely on PN [ 5 , 6 , 7 ] or EN [ 5 , 6 , 8 ] with no specific guidelines in relation to weaning PN, whilst minimizing the disruption to nutrient delivery during the incremental introduction of enteral feeds [ 1 ]. We recently proposed that the lack of specific TN phase nutrition recommendations weakens the nutritional management of the phase, and may be directly contributing to the accumulation of nutrient deficits [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

et al. 2018

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The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

et al. 2018

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“…Nevertheless, half of preterm infants in North America are discharged home from the NICU at less than the tenth percentile for weight [13]. Deficits in caloric intake accrue in the first weeks of life in preterm infants [14,15], while a decline in protein intake occurs during the transition from parenteral fluids to enteral nutrition [16][17][18]. Using CDS in the NICU to assist with ordering parenteral nutrition has been shown to reduce error and improve protein intake and growth; [8][9][10] however, studies to date are from single centers.…”

Section: Introductionmentioning

confidence: 99%

Low prevalence of clinical decision support to calculate caloric and fluid intake for infants in the neonatal intensive care unit

Falciglia¹,

Murthy²,

Holl³

et al. 2019

J Perinatol

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Background Clinical decision support (CDS) improves nutrition delivery for infants in the neonatal intensive care unit (NICU), however, the prevalence of CDS to support nutrition is unknown. Methods Online surveys, with telephone and email validation of responses, were administered to NICU clinicians in the Children's Hospital Neonatal Consortium (CHNC). We determined and compared the availability of CDS to calculate calories and fluid received in the prior 24 h, stratified by enteral and parenteral intake, using McNemar's test. Results Clinicians at all 34 CHNC hospitals responded with 98 of 108 (91%) surveys completed. NICUs have considerably less CDS to calculate enteral calories received than enteral fluid received (32% vs. 82%, p < 0.001) and less CDS to calculate parenteral calories received than parenteral fluid received (29% vs. 82%, p < 0.001). Discussion Most CHNC NICUs are unable to reliably and consistently monitor caloric intake delivered to critically ill infants at risk for growth failure.

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Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

Wong Vega,

Vuong,

Chmielewski

et al. 2023

Nut in Clin Prac

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Approximately 30% of all children and neonates admitted to the intensive care unit (ICU) experience acute kidney injury (AKI). Children with AKI are largely poorly fed and experience high rates of malnutrition. Nutrition prescription and provision are exceptionally challenging for critically ill neonates, infants, and children with AKI given the dynamic nature of AKI and its respective treatment modalities. Managing the nutrition prescription of critically ill neonates, infants, and children with AKI requires nutrition support clinicians to have a high‐level understanding of the various treatment modalities for AKI, which can affect the patient's protein, fluid, electrolyte, and mineral needs. Accurate and timely nutrition assessment in critically ill neonates and children with AKI can be flawed owing to difficulty obtaining accurate anthropometric parameters. Recently, the Pediatric Renal Nutrition Taskforce introduced clinical practice recommendations for the nutrition management of children with AKI. In this review, we will discuss the practical implications of these recent guidelines and work to bridge the knowledge and practice gaps for pediatric and neonatal nutrition support clinicians providing nutrition therapy for patients with AKI in the ICU. We also appraise special nutrition‐related considerations for neonates with AKI given newer available renal replacement treatment modalities.

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Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants

Cited by 19 publications

References 27 publications

Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

Low prevalence of clinical decision support to calculate caloric and fluid intake for infants in the neonatal intensive care unit

Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

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